Men and addiction

A global problem

What's surprising, however, is that few experts agree on what addiction really is, or what causes it.

You won't be surprised to learn that the use of addictive
drugs of all types is a global problem. What's surprising, however, is that
few experts agree on what addiction really is, or what causes it.

Some doctors and healthcare workers view addiction as a disease, whereas others see it as a problem of behaviour or emphasise the idea of
'addictive personality'. Yet the evidence for both concepts is
inconclusive.

As we will see, our attitude to addiction is just as much shaped
by cultural attitudes as by the medical evidence. But before we look at the
nature of addiction, and why it affects men more than women, we should remind
ourselves of the scale of the problem.

Drugs

The United Nations estimates that the world is host to:

8
million heroin users

13 million cocaine users

30 million users of
amphetamines

141 million cannabis users

227 million sedative users

1100
million tobacco smokers.

Over 100 million people are dependent on the tobacco
trade for their livelihood.

Alcohol

Alcohol is thought to cause around 33,000 deaths per year in
Britain, with one in four hospital admissions being related to alcohol.

Drinking is implicated in 60 per cent of suicides, 40 per cent of domestic
violence cases and 40 per cent of domestic fires.

Nicotine

Probably the most common and problematic substance with
potential for abuse, nicotine is highly addictive.

The various toxins in
cigarette smoke kill many thousands of people annually.

Gambling

Approximately 3 per cent of the British adult population has
a gambling problem. Of these, about 500,000 have a severe problem.

Legal drugs

Some estimates put the number of Britons addicted to
over-the-counter drugs and prescription drugs to be around 2 million.

Men and addiction

Men are much more likely to be addicted to alcohol and other
substances than women. Two thirds of attendees at
Alcoholics Anonymous
are men (although this figure was 80 per cent in 1972).

A large American study has found that men are twice as likely as
women to have a substance dependence disorder, with a lifetime prevalence of
almost 36 per cent for men and 18 per cent for women. In other words, over one
third of the male population of the US have been dependent on alcohol or drugs
at some stage of their lives.

Men in the 25 to 34 year age group were twice as likely as
those in the 45 to 50 year old age group to report substance dependency.
Alcohol and drug abuse are strongly associated with an increased
suicide rate in
men.

In a large British study men were three times more likely than
women to be alcohol dependent and twice as likely to be drug dependent. Almost
8 per cent of British men and almost 5 per cent of women said that they had
been drug dependent at some time in their lives, 3 per cent of men and 1 per
cent of women reporting dependence during the previous year.

Marriage appears
to protect men from addiction problems. Never being married or becoming single is associated with
increased alcohol consumption, while getting married is associated with a drop
in alcohol consumption.

Substance misuse

'Substance misuse' is a term used to describe the situation when a drinker or drug user
experiences mental or physical harm as a result of their habit without
necessarily being addicted to the substance in question.

Substance misuse needs to be contrasted with substance
dependence (also known as addiction).

Dependence occurs at a more advanced
stage of the addiction process.

Doctors make a diagnosis of addiction if three
or more of the following features are present.

A strong desire or sense of compulsion to take the
substance.

Difficulties controlling the substance-taking behaviour in terms of when it occurs, and or being able to stop, and or being unable to controlthe amount consumed once started.

A physically unpleasant withdrawal state when not consuming the
substance.

Further substance use to relieve or avoid the withdrawal
state.

Evidence of increased tolerance (increased doses are required
in order to achieve effects originally produced by lower doses).

Progressive neglect of alternative pleasures or interests
because of the substance use.

Persisting with substance use despite clear evidence of harmful
consequences.

Narrowing of a person's 'personal repertoire' or lifestyle – ie taking
the substance becomes more important than anything else.

The causes of addiction

There is much controversy as to the causes of addiction, not
least because the exact biology of addiction is unknown.

There are a number of
theories, briefly explained below, but none should be considered to be the
definitive account nor is any one theory mutually exclusive of any other.

It
appears that characteristics of the individual (including their personality),
the properties of alcohol and drugs, and environmental factors interact to
produce addiction. But it's difficult to determine whether the
individual's personality or their environment is the primary factor in
causing addiction.

Is alcoholism inherited?

A considerable body of research suggests that a tendency to
alcoholism may be inherited. Alcoholism seems to be much more common in some
families and this inherited type of alcoholism particularly affects men.

Individuals may inherit a higher tolerance for alcohol (they
need more drink than others to achieve the same effect), or they may inherit an
increased chance of becoming dependent.

One author has described two types of alcoholism, one of
which specifically affects men and may be inherited (though this idea is not
accepted by everyone).

Type I or 'milieu limited'

Affects men and women.

There's loss of control of drinking.

Parents will be non-abusers (or only mild
abusers).

There is no association with criminality.

Usually mild in severity.

Comes on after the age of 25.

The environment modifies the problem.

Not thought to be inherited.

Type II or 'male limited'

Affects men.

There is an inability to abstain.

Parents tend to be heavy abusers.

It is associated with criminality and novelty
seeking.

Usually a moderate/severe problem.

Comes on before the age of 25.

The environment is irrelevant.

Thought to be inherited.

The cognitive model of addiction

Cognition is the process by which we attain knowledge and
awareness of the world, and it has been argued that addiction is not inherited
but is a learned behaviour.

The more one consumes the more likely one is to be
become addicted. Addiction can thus happen to anyone.

The cognitive approach to addiction assumes that:

addictive behaviour is 'learned'

addiction is not a disease

the behaviour can thus be 'unlearned'.

Is there an addictive personality?

The phrase 'addictive personality' is used so
commonly in our culture that few of us question whether an addictive
personality type really exists, yet many doctors and psychiatrists believe that
the term means little or nothing. Certainly, there is little evidence for an addictive
personality as such.

Personality is complex and the role of personality in
addiction is uncertain.

It's difficult to disentangle the effects of
personality on addiction from the effects of addiction on personality.

There's
no single addictive personality. However, there are a number of personality
types that have been associated with addiction, and they are outlined below. The
strongest evidence exists for 'antisocial personality'.

The immature personality

Some people never really become mature adults. They may
remain unduly close to their parents. They often boast about those few things
that they have actually accomplished, are unable to form close relationships
with others, and are self-centred.

The anti-social personality

These people are unable to accept frustration. They live
for, expect and must have easy and continuous gratification. They often eat a
lot, chew sweets and smoke, as well as drink heavily. They drink for two reasons
– to reduce the personal discomfort that results from frustration and to
provide instant and dependable gratification. They are impulsive and do not
learn from their mistakes.

The self-punitive personality

Some outwardly docile people are actually repressing
aggressive tendencies. This results in inner tension and alcohol helps to
relieve this tension. Often alcohol releases the aggression.

The stressed or anxious personality

Some people find stress more difficult to deal with than
others. They may use alcohol in an attempt to cope.

The passive-aggressive personality

This term refers to someone with an outwardly calm and
acquiescent shell that hides inner anger. They find it impossible to deal with
anger-inducing situations.

Many addicts do not have these personality types, and of
course if you recognise yourself above it does not automatically follow that
you are at increased risk of addiction.

It's important to remember that no
personality is immune to addiction. Proneness to alcoholism is better
recognised by examining someone's existing drinking habits than by
assessing their personality.

Modern, well-organised studies do not support a role for
personality in addiction. Most of the theories outlined above are not well
supported by scientific evidence.

Does psychiatric illness lead to addiction?

Many alcoholics state that they drink because they are depressed. If one
goes into their life history the opposite is generally the case: they are
depressed because they drink. There is a sub-group, however, who do indeed
start to drink heavily to ward off depression.

Society and addiction

Societal or environmental factors are important.

Factors that
increase or reduce the availability of alcohol may influence the incidence of
alcoholism, eg if the cost of alcohol is increased or alcohol is made more
difficult to purchase the rates of alcoholism usually go down.

Cultural factors and addiction

Cultural factors are also important.

In some societies
consuming alcohol or other substances is less acceptable than in others. People
in some occupations are more likely to develop alcohol problems, eg publicans,
seamen, barmen and those in the armed forces. Many of these occupations are
more likely to involve men than women.

Drug addiction is particularly
associated with unemployment, poverty and urban decay. It is more common in men
than women.

Is addiction a disease or illness?

Most people with addiction problems feel that they have a
disease. Alcoholics Anonymous (AA), Narcotics Anonymous and Gamblers Anonymous
all see addiction as a disease.

Professionals mostly feel that the situation is more complex
than this. It must be recognised that viewing addiction as a disease helps many
people to overcome their problem. Unfortunately, some people see themselves as
passive victims of their illness, believing that 'there is nothing I can
do'.

The AA approach is to accept that one is 'powerless over
alcohol' and to put oneself in the hands of 'God, as we understand
him'. The evidence for biological and genetic factors being important in
addiction bolsters the illness argument, but there is also evidence for social
and psychological factors being important.

Low levels of serotonin – a brain chemical – appear to be an
important cause of addiction.

'Drugs of solace' may increase
serotonin levels and depressed people take them for this reason.

Alcohol raises
serotonin levels in the short term, but the levels fall in chronic alcoholics.
Ecstasy produces the same effect. Cigarettes may increase serotonin levels,
adding to their addictive properties. Gambling problems also seem to be associated with
low levels of serotonin.

Low levels of serotonin may be the result of inheritance, but
low status in society also seems to reduce serotonin levels. Drug and alcohol
abuse is more common in people from lower socio-economic backgrounds.

Therefore, these
drugs are described as rewarding or reinforcing. The fact that drugs and
alcohol are rewarding does not explain why some people become addicted but not
others, but it does lend weight to the argument that addiction is an illness or
disease.

How to recognise if you have an alcohol dependence
problem

Ask yourself the following four questions (the
CAGE questionnaire).

Have you ever felt that you should Cut down on your alcohol
consumption?

Have you ever felt Guilty about your alcohol consumption or the
consequences of alcohol consumption?

Have you ever had an Eye opener in the morning?

If you answer 'yes' to two or more of these questions, it's possible that you are drinking too much and should seek
help.

Treatment for addiction problems

The obvious answer to addiction is to stop taking the consumed
substance, but of course this is far from easy.

If you have any concerns
consult your doctor, who has a range of treatment options at his disposal.

The
important thing to remember is that help is available. Probably the most
important source of help (it reaches the greatest number of people) is
Alcoholics Anonymous. The 12-step approach of AA is useful for many people
though not for everyone.

Someone who has been consuming alcohol heavily may require
admission to the medical ward of a local hospital in order to ensure safe
withdrawal.

Coming off alcohol quickly can result in delirium tremens, which
can be a fatal condition and must be treated carefully. A drug called
chlordiazepoxide
can be given to help with withdrawal.

Those who are not drinking as heavily may be able to reduce
their intake at home with or without chlordiazepoxide. But while stopping
drinking is relatively easy, staying off drink is much more difficult.

In most parts of the country Community Addiction Teams now
exist. Nurses visit people in their own homes or see them in a local clinic and
provide support and advice.

A number of new types of medication are now available that
reduce the craving for substances, such as alcohol and nicotine, and can be
helpful for those who are already determined to give up. Without this
motivation to change, tablets will not help.

There is a range of other self-help groups and
support groups
throughout the country. The numbers of these groups can be found in the phone
book.

Treatment for drug dependence

Dependence on opiate drugs, such as heroin, is a serious
problem. There is a high risk of contracting a serious illness, such as
hepatitis B or AIDS, and a high risk of death by overdose or through accidental
injection of toxins that have found their way into the heroin supply.

If you are injecting heroin you should seek help immediately
through your local GP. In most parts of the country methadone
can be prescribed
as a substitute for heroin. In some parts of the country needle exchange
schemes are available – so that even if you continue to inject heroin, you can at
least do so in some safety. Good treatment services are available in many
regions, which help people to come off drugs.

Whether you consider your addiction to be a disease or simply a
manifestation of your character, it's important to realise that you have
options. You're not doomed to a life of addiction simply because you've
been an addict in the past.

You should also remember that you don't have
to face your addiction alone – your GP is there to help you get over it.

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